Provider Demographics
NPI:1477876084
Name:BOYD, MARY ANNETTE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNETTE
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N. HAMPTON RD.
Mailing Address - Street 2:SUITE 330
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2399
Mailing Address - Country:US
Mailing Address - Phone:972-283-6634
Mailing Address - Fax:972-283-6892
Practice Address - Street 1:1801 N HAMPTON RD
Practice Address - Street 2:SUITE 330
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2391
Practice Address - Country:US
Practice Address - Phone:972-283-6634
Practice Address - Fax:972-283-6892
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX013029163WH0200X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747508Medicare Oscar/Certification